Skin-directed Treatments for Skin Lymphomas

For many skin lymphomas (especially early-stage lymphomas), the first treatment is directed at the skin lesions themselves, while trying to avoid harmful side effects on the rest of the body.

There are many ways to treat skin lesions. Sometimes more than one type of treatment is used, either at the same time or one after another.

Surgery

Surgery is not usually used by itself to treat skin lymphoma, but it can be helpful in some situations.

• Biopsy: Surgery may be used to biopsy a skin lesion, lymph node, or other tissue to diagnose and classify a lymphoma.
• Treatment: Surgery is sometimes part of treatment for certain types of skin lymphomas if there are no more than a few skin lesions and those lesions can be removed completely. If surgery is done, it is often combined with other types of treatment.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. The treatment is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Treatment might be given in just one dose or on several days, depending on how much of the skin is being treated.

Electron beam radiation

Electron beam radiation is the type of radiation used most often for skin lymphomas.

The beam of electrons only penetrates as far as the skin, so there are few side effects to other organs and tissues. The main possible side effect of electron beam therapy is a skin reaction similar to a sunburn.

Total skin electron beam therapy (TSEBT)

For mycosis fungoides and Sezary syndrome covering a large part of the skin, electron beam therapy is sometimes given to the entire body. This is called total skin electron beam therapy (TSEBT).

Along with skin changes, this can sometimes cause loss of all hair on your body, dry skin, a reduced ability to sweat for several months, and even the loss of fingernails and toenails. However, any of these structures can be shielded if they don’t need to be treated.

High-energy radiation (x-rays or gamma rays)

Some thicker lymphomas that are not widespread (especially single lesions) are treated with high-energy radiation (like x-rays or gamma rays) instead of electrons.

This kind of radiation can penetrate deeper into the body. Because it can damage internal organs, the treatment is planned carefully so that most of the radiation goes only to the skin.

To learn more, see Radiation Therapy.

Phototherapy (UV light therapy)

Ultraviolet (UV) light is the higher-energy part of sunlight that causes sunburn and can lead to skin cancer. Phototherapy uses UV light to kill cancer cells in the skin. This is a useful treatment for some skin lymphomas that aren’t very thick, especially if they involve large areas of the skin.

Ultraviolet A (UVA) and ultraviolet B (UVB) can be used to treat skin lymphoma. Both UVA and UVB treatments are given with special fluorescent lamps like those used in tanning salons.

Just like the UV light in sunlight, these treatments can cause sunburn and may raise the risk of skin cancer later in life, so doctors try to avoid giving too much UV light. During treatment, your radiation team carefully controls the wavelength and dose of light to minimize your risk of burns.

Treatments are given several times a week.

Psoralens and UVA (PUVA)

When UVA is used, it is combined with drugs called psoralens. This combination is referred to as PUVA.

Psoralens are given as a pill about 2 hours before the treatment. The drug travels through your blood to reach cells throughout your body (including cells of skin lymphoma). When these cells are exposed to UVA light, the drug is activated, killing them.

Psoralens can cause some nausea. They can also make your skin and eyes very sensitive to sunlight, increasing the risk of severe skin burns and cataracts. It's important to protect yourself from sunlight as much as possible in the days after treatment.

Narrowband UVB (NB-UVB)

UVB (sometimes described as narrowband UVB, or NB-UVB) is given without any extra medicines. It is generally used for thinner skin lesions.

Topical medicines

Treatment that applies drugs directly to the skin is called topical therapy. It can be very helpful in treating many early skin lymphomas.

When a drug is put on your skin, its effects are concentrated on that spot, with much smaller amounts reaching the rest of your body. This can help limit side effects, especially for strong medicines such as some chemotherapy drugs.

Topical corticosteroids

These are drugs related to cortisol, a hormone made naturally in the body that can affect immune cells such as lymphocytes (the cells lymphomas start from).

Corticosteroid pills and injections into the blood have long been an important part of treating lymphomas. Topical forms of these drugs can also be applied directly to the skin as ointments, gels, foams, and creams (usually once or twice a day), or injected directly into skin lesions on a less frequent basis.

Long-term use of topical corticosteroids may cause the skin in that area to become thinner.

Topical chemotherapy drugs

Chemotherapy (chemo) drugs are medicines often given by mouth or injected into a vein to treat more advanced cancers, including advanced skin lymphomas. See Whole-body (Systemic) Treatments for Skin Lymphomas.

Some chemo drugs can be used to treat earlier forms of skin lymphoma by putting them directly on the skin, usually as a cream, ointment, or gel.

The drug most often used to treat skin lymphoma is mechlorethamine (nitrogen mustard). Possible side effects include redness, swelling, or irritation where the drug is applied, as well as an increased risk of other types of skin cancer in the area.

Topical retinoids

Retinoids are drugs related to vitamin A. By affecting certain genes in lymphoma cells, they can help them mature.

Some retinoids, such as bexarotene (Targretin), come in a gel that is applied directly to skin lesions. Possible side effects include redness, itching, irritation, and sensitivity to sunlight in the area where the drug is applied.

These drugs can cause birth defects, so they should not be used if you are pregnant or could become pregnant.

Topical immune therapy

Imiquimod (Zyclara) is a cream that causes an immune system reaction when applied to skin lesions, which may help destroy them. This drug is used mainly to treat other types of skin cancer, but some doctors may also use it to treat early forms of skin lymphoma.

It can cause redness, itching, and irritation where it is applied.